Kids Vision Partnership

State: TX Type: Model Practice Year: 2014

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Impaired vision can affect large numbers of children, impairing emotional, neurological, and physical development as well as school performances. These problems are exacerbated among children from low income neighborhoods with few resources for needs such as eyeglasses. Parents in these areas may be unaware of the importance of vision screening, or unable to provide children with the necessary vision exams and eyewear that can help them succeed in school and life. Over 19,000 Houston children in 21 school districts need vision care each year, but do not receive it.

The goal is to address unresolved vision problems for low-income school-aged children by removing barriers and providing services at a volume that will address the local need. The long term outcome is that children will improve academic performance and classroom behavior, and achieve greater future success in the workforce and society.

The primary objective for the 2013-2014 school year is to provide free eye exams and glasses to 10,000 school aged children in need. Additional objectives are described in the later section of this application, “LDH Collaboration and Implementation Strategy.”

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Houston Department of Health and Human Services
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Kids Vision Partnership
1. Location of LHDThe Kids Vision Partnership is led by the Houston Department of Health and Human Services (HDHHS). HDHHS is the public health authority for the city of Houston, Texas, with a population of 2.1 million. 2. Public Health Issue Impaired vision can affect large numbers of children, impairing emotional, neurological, and physical development as well as school performances. These problems are exacerbated among children from low income neighborhoods with few resources for needs such as eyeglasses. Parents in these areas may be unaware of the importance of vision screening, or unable to provide children with the necessary vision exams and eyewear that can help them succeed in school and life. Over 19,000 Houston children in 21 school districts need vision care each year, but do not receive it. 3. Goals and Objectives The goal is to address unresolved vision problems for low-income school-aged children by removing barriers and providing services at a volume that will address the local need. The long term outcome is that children will improve academic performance and classroom behavior, and achieve greater future success in the workforce and society. The primary objective for the 2013-2014 school year is to provide free eye exams and glasses to 10,000 school aged children in need. Additional objectives are described in the later section of this application, “LDH Collaboration and Implementation Strategy.” 4. How the Practice was Implemented Since 2007, the Houston Department of Health and Human Services (HDHHS) has partnered with One Sight, a Luxottica Group Foundation, to provide vision and exams and eyewear to students in Houston. In this model, area schools bus children to a vision clinic site where they receive free vision exams and prescriptions for eyeglasses, which are filled free of charge and delivered to children on site or at their schools. Based on the success of the OneSight model, HDHHS created a public/private partnership to provide vision exams and eye glasses for Houston area children. The local initiative is called “See to Succeed.” Both initiatives, OneSight and See to Succeed, work under the combined HDHHS leadership known as the Kids Vision Partnership and provide needed vision care to many thousands of children each year. The Kids Vision Partnership grew from the vision of Stephen Williams, Director of HDHHS, and brought together key partners including: • Berkeley Eye Center • San Jacinto College Eye Technology Program • University of Houston Optometry Program 5. Results/Outcomes/Milestones For each clinic, 100% of the children who are examined and need glasses are provided eyewear within 4-6 weeks of the examination date. The children who attend the clinics are pre-screened for vision problems, so over 85% need glasses. Each year the See to Succeed clinic capacity has grown. • 2010-2011 school year: 422 children were screened and if needed, fitted with eyewear at the initial pilot session • 2011-2012 school year: 6,200 children were examined • 2012-2013: 7,357 children were seen • 2013-2014: the target is 10,000 children 6. Were All Objectives Met? All past objectives were met, and the targets were raised for the current school year. New objectives were added as a part of the $1.6 million in funding received in 2012 from the Houston Endowment Foundation. 7. Factors Leading to the Success of the Practice Many factors contribute to the success of the HDHHS Vision Partnership, including: Partnership with established foundations such as OneSight, with proven methods Support of HDHHS, which allows employees to participate in the Vision Partnership missions as a part of their regular assigned duties Multiple funding and volunteer sources College and University partnerships--students and their instructors do most exams Business partners that donate eyeglass frames and other supplies Commitment to local schools and communities to return year after year 8. Public Health Impact of the Practice An evaluation conducted by The Houston Independent School District indicated that the vision services through the OneSight clinics is reaching the goal of improving academic outcomes for the children served. From 2009-2011, a total of 5,396 HISD students were provided services during the OneSight vision clinics. The report states that "the differences in TAKS reading/ELA scale score improvement across eye care treatment groups indicated that students who were treated at the OneSight Vision Clinics outperformed their peers who needed but did not receive eye care treatment” and noted that the attendance rate for students who received treatment at the OneSight Vision was improved. Additional evaluation is underway.
1. Description of LHDThe Houston Department of Health and Human Services (HDHHS) is the public health agency for the city of Houston, with a 2010 census population of 2.1 million. Houston is one of the most racially and ethnically diverse cities in the U.S. Residents are 25.6% white (non-Hispanic): 43.8% Hispanic, 23.7% black, 6.0% Asian, and 1% other. Many are poor; 22.8% of Houstonians live below the poverty level, compared to 15.2% nationwide. Houston is also a large city, with 579 square miles of land area. 2. Statement of the Problem/Public Health Issue Developmental disorders such as impaired vision can affect the ability of children to learn and become productive members of society. According to Prevent Blindness America, researchers in the field of vision and learning, and public school and prison officials: • More than 10 million children in the U.S. suffer from vision problems • 80% of learning in a child’s first 12 years comes through the eyes • 25% of all school children in the U.S. have a vision problem that affects learning and 20% need glasses • Vision is the #1 concern of school teachers • In a Dallas elementary school, after four classmates received glasses, the standardized test pass rate for that class improved from 85% to 96% • Children who don’t see well disengage from learning and are more likely to drop out of school • Among juvenile offenders, 78% have a vision problem, 56% have two or more vision problems, and 43% need glasses • 91% of adults inmates at Segoville and Fort Worth Federal prisons have vision problems • Prisons forecast the beds they will need in 10 years based on 3rd grade reading levels According to information from Prevent Blindness America, 25 percent of school age children have vision disabilities and 5 million adults have irreversible vision loss due to early childhood eye disease. In Houston, 25% of the population of 2.1 million is between ages 5 and 18, or 524,863 children. Each year, Houston and nearby schools provide vision screening for nearly half a million students. One-fourth of these children, or 131,216, can be expected to have a vision disability. 3. Target Population, Percentage Reached The most recently available Texas Department of State Health Services vision screening report revealed that a total of 416,224 school aged children were screened for vision problems in Houston and the surrounding area during the 2011-2012 school year. Of these, 47,038 (11.3%) failed the mandated school vision screening. Of the 47,038 children who failed and were also referred for follow-up, 19,226 or 40.8% of them still had unresolved vision problems at the end of the school year. It is this group of 19,226 children that the Kids Vision Partnership project works to assist. During the 2012-2013 school year, the Vision Partnership reached 7,357 children, or about 41 percent of the total in need. The Vision Partnership goal for 2013-2014 is 10,000 children, or about 51 percent of those estimated in need. 4. Past Interventions Schools have tried many avenues to assist children who have been identified as in need of glasses or other vision care. Nurses have made multiple attempts to encourage parents to take children to eye professionals. Some schools have issued vouchers that would pay for eye exams and given them to parents. Some schools participate with OneSight and other foundation efforts. And some optometrists and opthamologists provide free or sliding scale services for those with limited income. While these efforts are often effective, they are not organized on a level to begin to methodically identify and address the thousands of children who need professional eye care and do not receive this care. 5. Why the Kids Vision Partnership is BetterThe Kids Vision Partnership clinics remove all access barriers to providing comprehensive vision exams and eyewear for children who have been identified with a vision project. The project provides a much wider scope to serve many more children than any of the other interventions mentioned above. It moves beyond asking parents who may already be working two jobs and have limited time/money to seek professional eye care. Instead, the project accesses care for children through the schools. As working relationships have developed between Vision Partnership staff and school nurses and principals, each year brings more consistency in the plans and greater participation from the schools. 6. How the Kids Vision Partnership is Innovative (creative use of existing practice) The Vision Partnership is innovative for several reasons. One is that the project engages both the public and the private sectors to work on a large scale to solve a public health problem not often recognized or addressed by local health departments. Another is the adaptation of the OneSight model to a large urban area, with the involvement of multiple partnerships and the donation of hundreds of thousands of dollars in time and other resources for coordination, professional exams and referrals, eyeglasses, clinic support and volunteer activities. About 80 percent of the project resources are donated from school districts, cities, government agencies, colleges and universities, non-profit organizations and businesses. The project is also innovative in the scale of services. Now, in 2013, the program provides free vision exams and quality corrective eyewear to nearly half of the school children 6-18 years old in need of vision care. 7. Kids Vision Partnership is Evidence-Based; References Follow. Healthy People 2020 Kids Vision Partnership is aligned with the Healthy People 2020 goal V-5.1: Reduce visual impairment due to uncorrected refractive error in the population 12 years and older. References CDC Vision Health Initiative website. Available at http://www.cdc.gov/visionhealth/. • Estimates that U.S. total costs for vision loss equal $51 billion each year, due to medical costs, lost productivity, informal care costs, health utility costs, medical care expenditures, and other direct costs. Frick KD, et al. Economic impact of visual impairment and blindness in the United States. Archives of Ophthalmology. 2007;125:544-550. Available at http://www.hopkinsmedicine.org/wilmer/danacenter/publications/ gower_docs/economic_impact_blindness.pdf. • Links untreated vision problems with low literacy and educational attainment, and with increase criminality. Johnson R, Nottingham D, Stratton R, Zaba J. Journal of Behavioral Optometry. 1996;7:39. Available at http://www.vision-training.com/ • Reports childhood is a crucial time in the care of good sight, when healthy eye habits are established, and because vision problems can lead to delays in social, physical and educational development. Prevent Blindness America. Website available at http://www.preventblindness.org/ • Provides information on eye health and safety, reports and research, news, action steps, events, and more. Slusser W, Dudovitz R. UCLA School of Medicine and Public Health. September 26, 2013. • Study reported on the Vision to Learn website: New effort to deliver free glasses improves student performance, behavior and self-esteem. The research shows 95 percent of California public school children who need glasses do not have them and Vision to Learn’s direct delivery of vision care on school sites is having a significant impact on students and their classrooms. Available at http://www.visiontolearn.org Zaba JN. Children’s vision care in the 21st century and its impact on education, literacy, social issues, and the workplace: a call to action. J Behav Optom. 2011;22(2):39-41. Available at http://oepf.org/jbo/journals/22-2 Zaba.pdf. • Up to 74% of adults with literacy problems fail vision screening tests. An estimated 43% of adult prison inmates have not obtained a high school diploma; this low percent has been linked to vision problems.
The Houston Department of Health and Human Services (HDHHS), through the Kids Vision Partnership, collaborates with a variety of public and private partners to provide free eye exams and glasses to children in grades 1-12 during week-long vision clinics held at HDHHS service sites. The Partnership includes the locally supported and operated See to Succeed program and the OneSight vision program which is funded and operated by the OneSight Foundation with ancillary support from HDHHS.1. Goals and Objectives The overall goal for the project is to address unresolved vision problems for low-income school-aged children by removing barriers and providing services at a volume that will address the local need. The long term goal is children with improved academic performance and classroom behavior, with greater future success in the workforce and society. The project began with an initial goal to assemble the resources to expand capacity to provide free comprehensive exams and eyewear to 10,000 children each year. This goal was achieved in less than three years by creating a collaborative of people and agencies that were dedicated to the single mission of providing glasses to children in need. 2013-2014 Academic Year Goal: Assemble a group of partners who could bring the necessary resources to the table to expand the capacity of the vision initiative to serve 10,000 children per year. Objectives: At least 10,000 students will receive comprehensive vision exams and glasses during clinics at no cost 100% of children who attend a vision clinic and need glasses after a vision exam will be fitted with corrective lenses and a high quality frame The vision collaborative will provide funding, donated services, volunteers and other resources to support the screening, fitting of eyewear, and referral services at six one week vision clinics a year 2. Activities to Achieve the Goals and Objectives HDHHS began work in the area of vision screening and providing eyewear by working cooperatively with the OneSight program and learning their methods for setting up temporary clinics and screening large numbers of children in a variety of sites. While OneSight offers an excellent service, they can only provide 1-2 weeks of clinic time per year, and clearly much more is needed in the Houston area. To address the great unmet need in Houston for low income children to receive vision exams and eyewear, HDHHS took on the initial role of assembling a group of partners who could bring the necessary resources to the table to expand the capacity of the vision initiative to serve 10,000 children per year. HDHHS staff members, who were experienced with working with the OneSight Foundation were recruited to serve as expert resources in the development and implementation of the local See to Succeed clinic model. HDHHS assigned a project manager for the initiative to serve as facilitator and convener for the partnership, and assure that the safety net services are well organized and executed. The project manager from HDHHS leads the planning effort and coordinates the use of resources from all partners. HDHHS donates staff for planning and for staff support when clinics are held and uses its facilities as sites for vision clinics for OneSight and See to Succeed. HDHHS has also provided bridge funding for supplies, equipment and services for the project until sufficient philanthropic support was available.The project has benefited from broad based support from many sectors including the business community, the philanthropic community, the non-profit community and academia. Major Partners and Their Roles The Kids Vision Partnership relies on the key partners and their extensive support in every aspect of the initiative. The primary partners include: Houston Department of Health and Human Services Foundation. The HDHHS Foundation is a 501 (c)(3) non-profit organization formed in 2010 to provide a funding stream to support public health projects beyond the normal scope and capacity of city operations. The HDHHS Foundation is committed to eliminating the annual list of children with unresolved vision problems by assuring that all students in the Houston area in need have high quality corrective lenses. HDHHS Foundation board members have been very instrumental in bringing in additional resources to support the expansion of vision services for children. Essilor Vision Foundation is a Dallas-based 501 (c)(3) public charity founded in July 2007 with seed money from the Essilor Corporation. The Essilor Vision Foundation is a key partner in the Kids Vision Partnership initiative and contributes eyeglass frames and brings in free lenses from its affiliation with the Essilor Corporation. Staff from the Essilor Vision Foundation oversee the order entry for frames to the lab, receive and inspection frames after production in the lab and coordinate delivery of the frames to the children at the schools within 4-6 weeks of the clinic events. Berkeley Eye Center is recognized as one of Texas’ most established comprehensive eye care facilities. Berkeley Eye Center has contributed technical assistance and expertise to the See To Succeed project; recruited additional service providers; donated eyeglass frames; and provided optometrists, ophthalmologists and ophthalmology technicians to support the clinics. Opticians from the Berkeley Eye Center oversee and manage optical services for the clinics and ensure that each child gets a pair of glasses with the correct prescription and fit. Berkeley also provides follow-up care for children who are referred for specialized care as a result of services received at a See to Succeed clinic. University of Houston Eye Institute. Since 1952, the University of Houston College Of Optometry (UHCO) has trained optometrists to provide quality vision and eye care. As a collaborator in the Kids Vision Partnership initiative, UH has provided optometry lanes, equipment and optometrists. A faculty member from the University of Houston serves as clinical director for the See to Succeed project and provides medical oversight for the project. The clinical director recruits and schedules doctors and students, oversees daily operations at the clinic, and assures that problems identified during the clinic are appropriately referred and followed-up.San Jacinto College. San Jacinto College’s Vision Eye Technology program offers the only ophthalmic technician program in Texas and is only one of a few programs in the United States. The director of the San Jacinto College Eye Technology program serves as manager of screening for the See to Succeed clinics. San Jacinto College students perform pre-screening tests during the clinic which allows the optometrists to see a high volume of students per day. San Jacinto College contributes testing supplies and equipment as well to the project vision clinics. During the 2012-2013 school year, See to Succeed expanded to hold a clinic week on the campus of San Jacinto College in the Eye Technology program clinic suite, and thus provide access to a new access area. Walmart is a key corporate sponsor for the See to Succeed activity. The Walmart support for the project grew out of contacts made through a leadership program (National Urbans Fellow) in which the department participates. Walmart produces glasses for the project in its Dallas lab free of charge to the project. Additionally, Walmart has donated frames, provides volunteers to work the clinic events and provides opticians to assist with delivering glasses. The Planning Process The objectives of the project are met through an ongoing structured planning process which includes the following planning steps for every phase of the project: 1) Planning 2) Implementation 3) Evaluation 4) Process Improvement Planning is conducted at multiple levels. At the highest level, the HDHHS Director and representatives from partner agencies meet periodically to develop and review strategies for acquiring resources to support the project. Assembling resources was and continues to be a major objective as well as developing and perfecting a service delivery model that is efficient and effective. The project manager leads an operational team that is comprised of key staff members from the partner organizations including the University of Houston, San Jacinto College, the Berkeley Eye Center and the Essilor Vision Foundation. Prior to the beginning of each school year, the team holds weekly planning meetings to plan and organize resources for the upcoming vision clinics. Six major areas that are addressed in the team’s work plan: School coordination (led by HDHHS) Screening (led by San Jacinto College) Clinical services (led by the University of Houston) Optical services (led by the Berkeley Eye Center) Eyewear Delivery at Schools (led by the Essilor Vision Foundation) Administrative and logistical services (led by HDHHS) Due to the work of the team, the service delivery process has been improved and optimized such that the project has grown from the capacity to serve 300 children per day during the 2012-2013 school year to the capacity to serve 400 children per day during the 2013-2014 school year. Because of the planning team, the project has increased capacity by 33% without having to add additional service days.Implementing the Program Since 2007, over 35,000 children have been seen in OneSight and See to Succeed clinics and approximately 25,000 of them have received glasses. So, how did we successfully serve so many children and give away so many pairs of glasses? We effectively developed and maintained ongoing partnerships with organizations who share the vision of providing eyewear to all children in need and who are committed to the mission. The extensive resources that have been committed by the partners have allowed the project to grow from serving 422 children in the pilot week in February of 2011 to the capacity to serve 2,000 children per week in six one-week clinics for the 2013-2014 school year. During the school year, HDHHS and partners set up five temporary See to Succeed week-long clinics in a HDHHS clinic facility in Houston and one in Pasadena on the San Jacinto College campus, for a total of six. Additionally, HDHHS continues the partnership with the OneSight Foundation which provides a week-long vision clinic at one of the HDHHS multi-service centers. The OneSight program provides services for about 1,500 Houston children each school year in the week long clinic. In addition to assembling the array of collaborators from various sectors to address this public health issue, the Kids Vision Partnership has been successful by focusing on the mission and by providing infrastructure planning, implementation and evaluation processes that support the ongoing work of the partnership and inspire the partners to stay at the table as active participants. How does it work? Vision problems are identified during the state mandated screening process conducted by the schools, generally by the school nurse, for grades K, 1, 3, 5 and 7. When vision problems are detected, the schools contact the parents with a recommendation to seek professional care. Schools provide encouragement to the parents to follow through, and many also issue vouchers to help parents pay for the services. Many parents do seek out care for their children and resolve these problems on their own. However, at the end of the school year, over 19,000 children remain on the Houston area unresolved vision report, which is compiled from reports that each school files with the State of Texas Department of State Health Services. The Kids Vision Partnership clinics are designed to serve as the safety net system of care for these children. As a part of the planning process for Kids Vision clinics, parents sign consents for their children to attend. On the clinic day, school busses transport the children to the clinic sites, where up to 400 children can be see each day. Children are usually screened, fitted with eyewear, and referred if needed, within three hours. Eighty percent of the resources are donated. At the implementation level, an interagency planning team meets regularly to coordinate resources and plan activities that are necessary to implement the project. At the conclusion of the last vision clinic for the year, a summary report is presented to the leaders of the sponsoring organizations at a wrap up meeting for the year. During the meeting HDHHS presents project data, issues identified during the year, and lessons learned. The group reviews the information, brainstorms solutions and makes recommendations which serve as a guide for the next year’s activities.The project implementation phase includes a two-step management process. The overall initiative is managed as on ongoing special project with a designated project manager. The second step occurs during the actual clinic, which is conducted as a department wide event and uses the Incident Command System (ICS) to manage the project during the clinic week. ICS was developed as a part of the National Incident Management System by the U.S. Department of Homeland Security as a structure that will allow teams to rapidly come together to address large scale emergencies that may involve multiple disciplines and agencies. Using this model for the clinics allows staff and volunteers to readily assume their roles in the clinic process, which might be quite different from their usual day-to-day activities. This also provides practice for HDHHS employees and others to use the ICS system, which is activated in case of emergency, such as a hurricane. The Incident Command structure is used to manage the project during the actual clinic weeks. The Project Manager serves as Incident Commander, staff from HDHHS fill the roles of Operations Chief, Finance and Administration Chief, Logistics Chief, and Planning Chief. Other command staff roles are filled by the planning representatives from the University of Houston, San Jacinto College, the Berkeley Eye Center and the Essilor Vision Foundation. At the end of each day a hotwash discussion is held to identify operational issues for the day and activities that went well, and to make plans for the next clinic day. Information from the hotwashes are compiled in a report and this information is used as a basis of discussion for the end of the year meeting with the executive sponsors of the project. 3. Criteria for Selection to Receive the Services Students were selected to participate if they had been screened at the school, found in need of a professional examination, and had not received this follow-up by the end of the school year. 4. Time Frame for the Program The vision clinics are held during each academic school year which generally runs from September to May. Students whose parents have not had assured that the student has received the recommended professional eye exam are identified during the school year are scheduled for Vision Partnership clinics during school year. The early fall clinics target children from the prior school year who still had an unresolved vision problem at the end of that school year. The later fall clinics and the spring clinics target children who were identified with a vision problem during the current year’s state mandated vision screening process and whose problem has not been resolved after repeated reminders to the parents by school personnel. 5. Stakeholders and Roles The Story Behind the Project-—How the Core Team and Stakeholders Came About Stephen Williams, Director of HDHHS had a vision to provide free vision exams and eyewear to 10,000 Houston area children annually. He solicited a member of his American Leadership Forum class, Margaret Shannon, to help bring resources together to accomplish that goal. Margaret Shannon in turn involved her husband Joel Shannon, who also signed on as a private volunteer to support that goal. The Shannons are now members of the board of the Houston Department of Health and Human Services Foundation, which was created to support initiatives of the HDHHS. The Shannons began to look for resources to support the program. They made contact with several Foundation representatives and began to write grant proposals to fund the project. They also began to promote the proposed project to others. Joel Shannon talked about the idea to a woman he met on an air flight. She happened to be related to Dr. Ralph Berkeley, a nationally renowned opthamologist, and she introduced Mr. Shannon to Dr. Berkeley. Dr. Berkeley agreed that the Berkeley Eye Center would participate in the project. Mark Michilette, chief administrative officer for the Berkeley Eye Center invited Deborah Clarke, Program Director for the Eye Technology Program at San Jacinto College, to the project and she agreed to participate. Stephen Williams approached Dr. Marcus Piccolo at the University of Houston about the project and Dr. Piccolo decided that the University of Houston would participate. A planning team was developed which included staff from the Houston Department of Health and Human Services (HDHHS), the Berkeley Eye Center, San Jacinto College and the University of Houston. The planning team started meeting in the fall of 2010 and decided to plan and hold a pilot clinic in the spring of 2011. At that first pilot clinic, 422 children were seen during the week. Additional Stakeholders—School Districts Major stakeholders include the school districts whose children are served. This public/private approach to dealing with a public health issue has been successful in part due to the established relationships that HDHHS has with Houston area school districts for activities such as immunizations. The school districts are more open to participating in the project because the initiative is led by the health department and because the project serves all children, and not just those with insurance or Medicaid. The schools are often approached by private entities that wish to provide services but are not willing to serve all children, and therefore the schools are hesitant to participate. The project has successfully built on HDHHS relationships with the schools and has gained the full support of three large school districts: the Houston Independent School District, the Alief Independent School District and the Pasadena School District. These districts provide high level administrative staff who coordinate with the project team members to identify and bring children in need to the vision clinics. This project would not be successful without the cooperation of Houston area school districts and schools. 5a. Fostering Collaboration with Community Stakeholders The approach in approaching partners was to sell the mission and not to request specific resources. Each partner who became committed to the mission brought self-selected resources to the table from their area of expertise. HDHHS has three primary stakeholder groups with whom it maintains collaborative relationships: 1) The agencies and organizations that assist with planning and implementing the initiative 2) The school systems whose children are served and 3) The member organizations of the Kids Village for Life Coalition - Greater Houston. (This is the city wide coalition of stakeholders, including HDHHS, the HDHHS Foundation, and other stakeholder agencies created to ensure a coordinated strategy for assuring that all children in need of eye care receive the care they need.) The partners are committed to a shared vision and shared goals. The primary reason that the partners are able to maintain coordination is that each of the individuals who represent these organizations is entirely committed to the cause of the initiative. Each person is convinced that whatever resources they can make available should be brought to the project to ensure that children who need glasses to do well in school get them. The HDHHS project manager facilitates ongoing coordination for the initiative and works to maintain positive relationships with the partners. She leads short-term planning efforts for the individual clinic sessions, leads and provides continuity in planning for longer term planning goals and issues, and keeps partners informed of program status and plans. The Kids Vision Partnership has also been successful in engaging professional and community partners. Identifying and maintaining relationships with organizations with similar interests and goals is key to these successful collaborations, as is focusing on common objectives associated with each project. For example, while each of the vision collaborators has an individual goal for the organization's ongoing work, each collaborator is united by the common goal of putting glasses on children with unresolved vision needs. Engaging schools has been a challenge for the Kids Vision Partnership. Prior to the 2011-2012 school year, efforts were made to engage schools at the individual school level. The Vision Partnership soon learned that it was important to engage school district officials at the executive management level to gain full participation from the schools. As a result, project leaders now work with school officials early in the planning phase to coordinate services and address barriers that pose problems for individual schools such as funds for transportation. 6) Costs and Funding Average cash costs per clinic week are $66,000, and are primarily for professional services: Optometry, Optical and Opthamology. Another $350,000 to $400,000 is provided for the week through in-kind staffing services from the University of Houston, Essilor, Berkeley Eye Center, San Jacinto College, and the Houston Department of Health and Human Services. The Kids Vision Partnership conducts an average of six week-long clinics, so total costs are roughly $462,000 per year, with $2.3 million in in-kind services and donated glasses. Current and past funding for the project has come from the following sources: Houston Independent School District Foundation $200,000, Reliant $50,000 Rockwell Fund $50,000 The Cullen Foundation $25,000 Baxter Trust $10,000 Christus Health $9,000 St. Luke's Episcopal Health Charities $5,000 The Houston Endowment Foundation $500,000 per year in new funding
1. What Did you Find Out? Were the Objectives Achieved?The results were encouraging, and provided a basis for continuing and expanding the project. Students who received needed glasses showed improved academic performance, better classroom behavior, and more consistent attendance. Participants, including students, chaperones, professionals, staff and volunteers, were generally pleased and rewarded by the experience. More detail on what was learned follows in later parts of this section. Yes, objectives were achieved for each year, and then target numbers were increased for the next year. Objectives for the 2012-2013 school year: 1) At least 7,000 students will receive comprehensive vision exams and glasses during clinics at no cost to the student. Achieved: Yes. New objective is 10,000 for school year 2013-2014. 2) 100% of children who attend a vision clinic and need glasses after a vision exam will be fitted with corrective lenses and a high quality frame. Achieved: Yes. 3) The vision collaborative will provide funding, donated services, volunteers and other resources to support the screening, fitting of eyewear, and referral services at six one week vision clinics a year. Achieved: Yes 2. Evaluation of the Project Both outcome and process evaluations were completed. 2b. Primary Data Sources The outcome evaluation data was collected by the Houston Independent School District, and looked at students’ academic performance, classroom behavior and attendance records. Process evaluation was collected by questionnaire at the clinic sites from staff at various levels working at the clinics, school nurses and chaperones, and the students who attended the clinics. 2c. Performance Measures An evaluation report conducted by The Houston Independent School District (HISD) indicates that the project to provide vision services through the OneSight clinics is reaching the goal of improving academic outcomes for the children served. The report describes program participation, school program coordinator feedback, and the student attendance and performance on the STAAR reading, STAAR EOC English I Reading, and TAKS English/Language Arts of students in the Vision Partnership program. The Vision Partnership provides an opportunity for HISD students to receive eye care and correction at no cost to their families. HISD Evaluation Methods (This Methods section, with data collection and data analysis was excerpted from the HISD report.) HISD Data Collection: Multiple sources of data were used in the evaluation of this program. The primary source of data on program utilization was collected by the City of Houston which kept extensive files of student participation in One Sight Vision Clinics. Information on the implementation of the program at the school level was collected through an Internet-based survey of program coordinators. In addition, observation of the February 2011 One Sight Vision Clinic was conducted. Academic outcomes data were collected and archived through the Public Education Information Management System (PEIMS) and Texas Assessment of Knowledge and Skills (TAKS) data files. Information on student performance on eye examinations was captured from the Chancery Student Information System. 2d. Data AnalysisHISD Data Analysis: To understand the impact of the One Sight Vision Partnership on student performance, the analysis compared performance indicators for the year prior to One Sight participation to performance the year of One Sight participation (referred to as a two-year comparison) and/or to performance the year following One Sight participation (referred to as a three-year comparison). Performance indicators used include school attendance rates and academic achievement (measured by the change in scale scores on the TAKS reading/English Language Arts (ELA) examination). At the elementary and middle school levels, the variable of interest was the magnitude of change in TAKS reading scale scores. At the high school level, the variable of interest was the average scale score on the TAKS ELA examination for each grade level. Change in performance was measured in two steps. In the first step, basic comparison of means tests (e.g., ANOVAs) were conducted to determine if differences in outcomes for students who needed vision correction and those who did not need vision correction were statistically different. A statistically significant difference would indicate that experiencing a vision deficiency was correlated with performance. A second step used ANOVAs to compare the outcomes of One Sight participants to students who needed vision correction and were seen by other eye care professionals, and to students who needed vision correction and did not receive treatment. A statistically significant difference would indicate the extent to which treatment by the One Sight Vision Clinic would improve student performance in comparison to receiving no treatment or in comparison to receiving treatment from a different eye care provider. HISD Evaluation Key Findings: In the 2011–2012 school year, 4,245 students enrolled in HISD campuses received services from the Vision Partnership. In the past three years of the partnership, 9,641 HISD students have received services through the program. Just over 90 percent (N=3,842) of students who attended a Vision Partnership Clinic in the 2011–2012 school year received eyewear. In general, students who received eyewear through the Vision Partnership slightly out-performed on the state academic assessments as compared to their peers who were referred to the Vision Partnership, but did not need correction. Attendance rates for students who received eyewear through the Vision Partnership were higher than both non-vision partnership groups in K–9 and 12. Overall, campus nurse coordinators viewed the program favorably. Their suggestions for improvement revealed a need for greater alignment between timelines developed by Vision Partnership personnel and campus service timelines. (note: the full HISD report is included as an attachment) Based in part upon these positive results, the See to Succeed Project applied for and received additional funding to enable capacity expansion to 400 students per day, with an annual goal of 10,000 students per school year, and has increased collaborative efforts with the vision partners. Process Evaluation—Methods, Data Sources, Measures, Results Tracking student and service data and information is a key component in evaluating the project's success. To achieve this end, process evaluation is completed at each See to Succeed event. Questionnaires are distributed to school chaperones, older children, staff, and volunteers. Each is asked to rate different aspects of their experience during the clinic day. Results from these questionnaires are then discussed in the end of day Hotwash sessions, and entered into Survey Monkey for analysis. A summary of questionnaires from the past school year show that 100% said our staff was pleasant and helpful; 100% would also recommend Kids for Life to others. Interesting, some of the children complained about the time they were there at the project—they wished they could have stayed longer! An end of day Hotwash meeting is held for the professional clinic staff, and a separate one for the HDHHS staff assigned for the week to direct traffic flow and manage other parts of the clinic. At these sessions, personnel are asked “What Went Well?” and “What Needs Improvement?” Answers are incorporated to the overall clinic process and those that can be implemented the next day are implemented. 2e. Modifications Made to the Practice as a Result of Data Findings Many modifications have been made based on the evaluations. The project scope has been expanded and grant funding has been supported by the positive HISD evaluation. Process evaluations done at the clinic sites have led to improved student flow through the clinics, more efficient use of in-kind and volunteer staff, better lunches, and more organized supply areas, as a few. 3. Future Evaluation Plans The HDHHS Foundation, on behalf of the See to Succeed project, recently obtained $1.6 million in funding from the local Houston Endowment Foundation. As a part of that funding, more extensive evaluation will be completed. This project will develop a data management system and evaluation team to design and implement systems to measure and support achievement of intended goals and objectives. Data will be collected in an integrated system that readily aligns with systems utilized by the school districts. The team that will support the project expansion will use previously validated tools to demonstrate positive outcomes. The team will used a mixed method plan with qualitative and quantitative data and measure intermediate term and long term outcomes, tracking these over time. Qualitative tools will be in the form of parent interviews, student interviews, and school staff interviews to determine facilitators and barriers to successful program implementation and expansion. 4. Anecdotal Evaluation of Success Many anecdotal situations demonstrate the successfulness of this model in identifying and resolving serious vision problems for children. One example arose at a See To Succeed vision clinic held during the 2011-2012 school year. The internal eye exam and a high intraocular pressure reading from one of the vision screening tests revealed that a young participant potentially had glaucoma. Glaucoma is an eye condition that develops when too much fluid pressure builds up inside the eye. The increased pressure can damage the optic nerve. If damage to the optic nerve from high eye pressure continues, glaucoma will cause loss of vision. Without treatment, glaucoma can cause total permanent blindness within a few years. The See To Succeed clinic staff arranged for the child to be seen by a private ophthamologist the next day, where the diagnosis of glaucoma was confirmed. The child was started on treatment immediately and participation in See To Succeed likely prevented permanent blindness.   Identified barriers will be addressed to achieve the best possible outcome. The quantitative measures will be tracked by analyzing data on two cohort groups of students with similar socio-demographics. Students will be the unit of measure. Changes in mean scores, t-tests and ANOVAS will be utilized to test differences between groups and changes in outcome over time.
Sustainability has been a central part of the planning process since the inception of the Kids Vision Partnership. At each step of the way, HDHHS and partners kept the core goal in mind—to address unresolved vision problems for low-income school-aged children. All knew that this would need to be a long term commitment, as new lists of students with unresolved vision problems were created at the end of each school year. Expanding funding sources, recruiting volunteers for professional and support roles, incorporating lessons learned to improve processes, increasing efficiency, expanding capacity, and developing the ever-increasing support of partners were known to be crucial in achieving the long term goal.1. Lessons Learned in Relation to the Practice The Kids Vision Project also has clarified these general guidelines for a successful project: Set a vision that can be shared • Be clear about the mission Identify partners who share the vision and commit to the mission Allow partners to identify a role that fits their interest and expertise Provide support from a lead agency to provide continuity and ongoing coordination Be flexible and willing to continuously improve the process Recognize and value the work of each partners 2. Lessons Learned in Relation to Partner Collaboration In general, the following lessons have been learned from past Vision Partnership efforts: The Incident Command Structure (ICS) can be used to effectively manage high-volume walk-through events that provide health care services. Cooperation from school districts and communities hinges upon the level of buy-in. Creating this buy-in is a key component of the vision screening project. Training volunteers is necessary for successful implementation of the program. Vision care services are considered critical to school performance by all involved. Additionally, the project has planning tools that could assist other communities in developing a vision services project similar to this one. 3. How the Kids Vision Partnership is Better than Prior Efforts This practice is an enhancement on efforts that have been previously done to resolve vision problems for children. The voucher systems which have been in place for some time have effectively provided access to free exams and glasses to children who are motivated or have few barriers that would prevent them from taking children referred to a see a private doctor. This system removes access barriers such as transportation and lack of parental follow through by bringing the children to the services with parental consent. Additionally, because of the structure of the clinic operations, a high volume of children can be seen through these clinics at a scale which can make a significant dent in the unresolved vision problem. 4. Cost/Benefit Analysis A cost benefit analysis has not been done for this project. However, the cash cost for providing a comprehensive exam and a pair of glasses for this population is around $35. The projected cost if the parent had to pay for the comprehensive exam and quality pair of basic glasses is $150. 5. Sustainability—Stakeholder Commitment Partner commitment has been a key to the Vision Partnership from the beginning, and remains a crucial aspect of the project. The current stakeholders have shown tremendous commitment and interest in continuing the project. In many ways, the Partnership has created a win-win for the participants. The schools are able to assist students and teachers through improved classroom performance among those students who receive needed glasses; San Jacinto College and the University of Houston have a rewarding and practical experience for their optical and optometry students; Walmart and other donors receive positive community reports about their work; HDHHS staff enjoy the project and participate in training that is useful for emergency preparedness; and many other professional and community volunteers feel rewarded in their support for the project. Stakeholder commitment is a strong plus for the Vision Partnership. 5a. Sustainability Plans Developing a sustainable system that provides vision care to children in need is vital to long term success of the project and to achieving continuous improvement in the health and success of children. In the Houston area, vision services are currently funded through a variety of resources including private donations, foundation funding, public and private funding and in-kind services from corporate and for profit companies. The project will continue to seek these sources of funds in addition to identifying reimbursements for services that are available through Medicaid, CHIP and other public insurance programs. In 2011, HDHHS and the HDHHS Foundation along with some of its existing stakeholder agencies established a citywide coalition to develop and oversee a collaborative, coordinated strategy for assuring that all children in need of eye care receive the care needed. The collaborative allows each organization to maintain its independence, core functions and vision programs while allowing strategic alignment to maximize use of existing resources and acquisition of new resources and support. That collaborative is now called the Kids Vision for Life Houston Area Coalition. The See to Succeed project has been successful in securing donation and grant funding, and enjoys the strong support of HDHHS and the HDHHS Foundation, as was shown in the budget section. In addition to secure funding, the project maintains sustainability through: Engaging the school districts to assure full participation and utilization of all services offered (vouchers, mobile units, vision clinics) Evaluating results to prove effectiveness Maintaining effective collaborations with contributing and potential partners Recruiting and retaining committed volunteer support Implementing activities to increase return rates for parental consents
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